Hiding in Plain Sight


Criminals who commit fraud are adept at hiding it in plain sight. Today ‘s fraudster and her son hid their fraudulent actions behind her high-profile position as owner of a respected home health care company and founder of a related charity. (Sometimes the bigger they are, the harder they fall.) The mother-son duo deceptively hid behind a scam that stole $16.5 million from the Medicare health care program.

The woman at the center of today ‘s case opened a home health care agency that purportedly provided a variety of skilled nursing services to home-bound Medicare patients. She also founded a related charity through which she funneled the illegal proceeds she obtained from Medicare. (How clever. She probably thought that no one would suspect such a community-minded person.)

The woman and her son paid thousands of dollars in kickbacks to doctors in exchange for Medicare patient referrals who required home bound services. They also paid bribes to the patients through the charity. (The mother and her son submitted more than $16 million in fraudulent claims to Medicare. They diverted the funds through her charity, then spent the proceeds on themselves.)

It ‘s important to note the age of today ‘s fraudster (82) and her position as a prominent member in the Cuban exile community, a board member of the Latin Chamber of Commerce and former winner of an “Entrepreneur of the Year” award. (In this case, wisdom did not come with age.)

The elderly mom pleaded guilty to conspiracy to pay kickbacks for patient referrals to her home health care agency. She opted for a plea deal rather than a trial so that her potential prison time would be capped. She ‘s headed to prison to serve five years behind bars. (Not exactly the way you want to spend your golden years.)

The woman ‘s 56-year-old son pleaded guilty to defrauding Medicare. He also received five years behind bars. (His defense attorney asked for a shorter sentence because he was instrumental in getting his mom to plead guilty, but the judge didn’t fall for it. Good try.)

So much for winning the “Entrepreneur of the Year” award. (Perhaps “Fraudster of the Year” would have been more appropriate.) Here ‘s wishing the government good luck with recovering the $16.3 million from the dynamic duo. (You can be sure that the government will find every asset this woman and her son have tried to hide in order to recoup their loss.)

Source: Today’s “Fraud of the Day” is based on an article entitled, “Businesswoman who won entrepreneur award sentenced to five years for Medicare fraud,” published by the Miami Herald on April 28, 2017.

A healthcare operator who once won an entrepreneur of the year award from the Latin Chamber of Commerce in Miami will be heading to prison for five years for submitting more than $16 million in phony claims to the taxpayer-funded Medicare program.

Martha Lima, 82, must surrender in early November after pleading guilty to a conspiracy to pay kickbacks to doctors for patient referrals to her home healthcare agency.

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Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.